Integrated Clinical-Occupational Management for Workers With Chronic Noncommunicable Diseases

Work ability will be assessed using the Work Ability Index (WAI), a standardized and validated questionnaire evaluating the worker's perceived ability to work in relation to job demands, health status, diagnosed diseases, sickness absence, future work ability expectations, and psychological resources. The total WAI score ranges from 7 to 49, with higher scores indicating better work ability. Change in WAI score will be assessed by comparing baseline values with values collected at the 12-month follow-up.

Disease activity in participants with inflammatory bowel disease will be assessed using validated clinical indices. Crohn's disease activity will be evaluated using the Crohn's Disease Activity Index (CDAI), which combines patient-reported symptoms, clinical findings, and laboratory parameters collected over 7 days. The CDAI score generally ranges from 0 to 600, with higher scores indicating greater disease activity. Ulcerative colitis activity will be evaluated using the Mayo Score, which includes stool frequency, rectal bleeding, endoscopic findings, and physician global assessment. The Mayo Score ranges from 0 to 12, with higher scores indicating greater inflammatory activity.

The clinical and pathological profile of participants with breast cancer will be described using tumor staging, histological grading, and molecular classification. Tumor stage will be assessed according to the TNM classification, which evaluates tumor size and local extension, regional lymph node involvement, and distant metastases. Histological grading will be assessed using the Nottingham system, based on tubular formation, nuclear pleomorphism, and mitotic index. Molecular classification will be based on biological markers including estrogen receptor, progesterone receptor, HER2 status, and Ki-67, allowing classification into clinically relevant breast cancer subtypes.

Functioning, disability, and work participation will be assessed using the International Classification of Functioning, Disability and Health (ICF). The ICF provides a multidimensional framework to describe body functions and structures, activities and participation, and contextual factors, including environmental and personal factors. In this study, the ICF will be used to identify functional limitations, restrictions in work-related activities, and environmental barriers or facilitators relevant to job retention and return to work.

Work productivity and activity impairment will be assessed using the Work Productivity and Activity Impairment Questionnaire (WPAI). The WPAI-General Health version will be used for participants with breast cancer, while the WPAI-Specific Health Problem version will be used for participants with inflammatory bowel disease. The WPAI evaluates employment status, hours missed from work, hours worked, impairment while working, overall work productivity loss, and activity impairment over the previous 7 days. Results are expressed as percentages, with higher values indicating greater impairment.

Worker well-being will be assessed using the NIOSH Worker Well-Being Questionnaire (NIOSH WellBQ), in the validated Italian version. The questionnaire evaluates worker well-being from a holistic perspective across five domains: work evaluation and experience, workplace policies and culture, workplace physical environment and safety climate, health status, and home, community, and society. The instrument includes 126 items and provides domain-specific indices and scales; it does not provide clinical diagnostic cut-offs.

Health-related quality of life will be assessed using the Medical Outcomes Study Short Form-36 Health Survey (SF-36). The SF-36 is a 36-item self-administered questionnaire assessing eight domains: physical functioning, role limitations due to physical health, bodily pain, general health perception, vitality, social functioning, role limitations due to emotional problems, and mental health. Scores are transformed on a 0 to 100 scale, with higher scores indicating better perceived quality of life. Physical and mental component summary scores may also be calculated.

Depression, anxiety, and stress symptoms will be assessed using the Depression Anxiety Stress Scales-21 items (DASS-21). The DASS-21 is a self-report psychometric instrument composed of 21 items divided into three 7-item subscales assessing depression, anxiety, and stress. Each item is rated on a 4-point Likert scale according to symptom frequency during the previous week, with higher scores indicating greater symptom severity.

Psychological well-being will be assessed using the Psychological General Well-Being Index (PGWBI). The PGWBI is a 22-item questionnaire evaluating perceived emotional and psychological well-being over the previous 4 weeks. It includes six dimensions: anxiety, depression, positive well-being, self-control, general health, and vitality. The total score ranges from 0 to 110, with higher scores indicating better psychological well-being

Fatigue will be assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-Fatigue). The FACIT-Fatigue is a standardized and validated 13-item patient-reported outcome measure evaluating fatigue intensity, energy level, ability to perform daily, work, and social activities, and the impact of fatigue on physical and psychological well-being during the previous 7 days. The total score ranges from 0 to 52, with higher scores indicating lower fatigue severity and better global functioning.